Maria C. Katapodi

Use of Pharmacologic Interventions for Breast Cancer Risk Reduction: American Society of Clinical Oncology Clinical Practice Guideline

PURPOSE To update the 2009 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction. METHODS A systematic review of randomized controlled trials and meta-analyses published from June 2007 through June 2012 was completed using MEDLINE and Cochrane Collaboration Library. Primary outcome of interest was BC incidence (invasive and noninvasive). Secondary outcomes included BC mortality, adverse events, and net health benefits. Guideline recommendations were revised based on an Update Committees review of the literature. RESULTS Nineteen articles met the selection criteria. Six chemoprevention agents were identified: tamoxifen, raloxifene, arzoxifene, lasofoxifene, exemestane, and anastrozole. RECOMMENDATIONS In women at increased risk of BC age ≥ 35 years, tamoxifen (20 mg per day for 5 years) should be discussed as an option to reduce the risk of estrogen receptor (ER) -positive BC. In postmenopausal women, raloxifene (60 mg per day for 5 years) and exemestane (25 mg per day for 5 years) should also be discussed as options for BC risk reduction. Those at increased BC risk are defined as individuals with a 5-year projected absolute risk of BC ≥ 1.66% (based on the National Cancer Institute BC Risk Assessment Tool or an equivalent measure) or women diagnosed with lobular carcinoma in situ. Use of other selective ER modulators or other aromatase inhibitors to lower BC risk is not recommended outside of a clinical trial. Health care providers are encouraged to discuss the option of chemoprevention among women at increased BC risk. The discussion should include the specific risks and benefits associated with each chemopreventive agent.

The influence of social support on breast cancer screening in a multicultural community sample.

PURPOSE/OBJECTIVES To examine the relationship between womens reported social support and their adherence to recommended breast cancer screening guidelines. DESIGN Descriptive, cross-sectional survey. SETTING Community womens organizations throughout the San Francisco Bay Area. SAMPLE 833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors. METHODS Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbachs alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of womens organizations conducted the survey in work and community settings. MAIN RESEARCH VARIABLES Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation. FINDINGS Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support. CONCLUSIONS Social support is associated with adherence to breast cancer screening guidelines. IMPLICATIONS FOR NURSING Nurses should assess womens levels of social support as a factor when evaluating adherence to breast cancer screening guidelines.

The Impact of Caregiving on the Psychological Well-Being of Family Caregivers and Cancer Patients

OBJECTIVES To provide an overview of patient and caregiver emotional distress; examine the sources of their distress, review evidence-based interventions that can reduce distress, and provide guidelines for assessment and intervention. DATA SOURCES Peer-reviewed publications. CONCLUSION There is a significant, reciprocal relationship between patient and caregiver emotional distress. Sources of distress vary by phase of illness. Evidence-based interventions can reduce distress and anxiety, but often are not implemented in practice. IMPLICATIONS FOR NURSING PRACTICE Nurses need to assess patients and family caregivers for distress and intervene to reduce distress by fostering patient-caregiver teamwork, communication, and self-care; providing information; and referring to resources as needed.

A tailored web-based psychoeducational intervention for cancer patients and their family caregivers

Background: Most programs addressing psychosocial concerns of cancer survivors are in-person programs that are expensive to deliver, have limited availability, and seldom deal with caregivers’ concerns. Objective: This study examined the feasibility of translating an efficacious nurse-delivered program (FOCUS Program) for patients and their caregivers to a tailored, dyadic Web-based format. Specific aims were to (1) test the preliminary effects of the Web-based intervention on patient and caregiver outcomes, (2) examine participants’ program satisfaction, and (3) determine the feasibility of using a Web-based delivery format. Methods: A phase 2 feasibility study was conducted with cancer patients (lung, breast, colorectal, prostate) and their family caregivers (N = 38 dyads). The Web-based intervention provided information and support tailored to the unique characteristics of each patient, caregiver, and their dyadic relationship. Primary outcomes were emotional distress and quality of life. Secondary outcomes were benefits of illness/caregiving, communication, support, and self-efficacy. Analyses included descriptive statistics and repeated-measures analysis of variance. Results: Dyads had a significant decrease in emotional distress, increase in quality of life, and perceived more benefits of illness/caregiving. Caregivers also had significant improvement in self-efficacy. There were no changes in communication. Participants were satisfied with program usability, but recommended additional content. Conclusions: It was possible to translate a clinician-delivered program to a Web-based format that was easy to use and had positive effects on dyadic outcomes. Implications for Practice: The Web-based program is a promising way to provide psychosocial care to more patients and caregivers using fewer personnel. It needs further testing in a larger randomized clinical trial.

Why some women have an optimistic or a pessimistic bias about their breast cancer risk: experiences, heuristics, and knowledge of risk factors.

Perceived risk to a health problem is formed by inferential rules called heuristics and by comparative judgments that assess how ones risk compares to the risk of others. The purpose of this cross-sectional, community-based survey was to examine how experiences with breast cancer, knowledge of risk factors, and specific heuristics inform risk judgments for oneself, for friends/peers, and comparative judgments for breast cancer (risk friends/peers − risk self). We recruited an English-speaking, multicultural (57% nonwhite) sample of 184 middle-aged (47 ± 12 years old), well-educated women. Fifty percent of participants perceived that their breast cancer risk was the same as the risk of their friends/peers; 10% were pessimistic (risk friends/peers − risk self < 0), whereas 40% were optimistic (risk friends/peers − risk self > 0). Family history of breast cancer and worry informed risk judgments for oneself. The availability and cultural heuristics specific for black women informed risk judgments for friends/peers. Knowledge of risk factors and interactions of knowledge with the availability, representativeness, and simulation heuristics informed comparative judgments (risk friends/peers − risk self). We discuss cognitive mechanisms with which experiences, knowledge, and heuristics influence comparative breast cancer risk judgments. Risk communication interventions should assess knowledge deficits, contextual variables, and specific heuristics that activate differential information processing mechanisms.

Prospective assessment of fatigue and health status in Greek patients with breast cancer undergoing adjuvant radiotherapy.

PURPOSE/OBJECTIVES To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status. DESIGN Prospective, descriptive, repeated measures. SETTING A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece. SAMPLE Consecutive sample of 106 women (mean age = 55 + 12), with histologically confirmed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks. METHODS Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2). MAIN RESEARCH VARIABLES Fatigue, health status. FINDINGS Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36. CONCLUSIONS Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status. IMPLICATIONS FOR NURSING Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.

Do women in the community recognize hereditary and sporadic breast cancer risk factors

PURPOSE/OBJECTIVES To describe knowledge of hereditary, familial, and sporadic breast cancer risk factors among women in the community and to identify characteristics associated with this knowledge. DESIGN Descriptive, cross-sectional. SETTING Community settings in the San Francisco Bay Area. SAMPLE 184 women who had never been diagnosed with cancer, were 30-85 years old (mean = 47 + 12), and agreed to complete a questionnaire in English. Participants were from diverse racial and cultural backgrounds (i.e., 43% European descent, 27% African descent, 16% Asian descent, and 14% Hispanic descent). Many (49%) were college graduates, and 24% had a median annual family income of

The 2014-2018 oncology nursing society research agenda

30,000-

Differences Between Women Who Pursued Genetic Testing for Hereditary Breast and Ovarian Cancer and Their At-Risk Relatives Who Did Not

50,000. METHODS Survey. MAIN RESEARCH VARIABLES Knowledge of hereditary, familial, and sporadic breast cancer risk factors and characteristics associated with this knowledge. FINDINGS Although most women recognized heredity as a risk factor, some did not understand the impact of paternal family history on risk. Some women did not recognize the relationship between breast and ovarian cancer, risk factors associated with the Gail model, and that aging increases risk. Education level was the most important characteristic associated with knowledge of risk factors. CONCLUSIONS Although age and family history are independent predictors of sporadic, hereditary, and familial breast cancer risk, women in the community could not distinguish between the three forms of the disease. Although the sample included a large number of educated women, their knowledge of breast cancer risk factors appeared incomplete. IMPLICATIONS FOR NURSING Advanced practice nurses should provide individualized risk assessment and education regarding breast cancer risk factors.

Advanced nursing practice and research contributions to precision medicine.

PURPOSE/OBJECTIVES To identify priority areas of research for the Oncology Nursing Society (ONS) Research Agenda for 2014-2018, consistent with ONSs mission to promote excellence in oncology nursing and quality cancer care
. DATA SOURCES Review of the literature, 2013 ONS Research Priorities Survey, National Institute of Nursing Research, and the National Cancer Institute research foci
. DATA SYNTHESIS Multimethod consensus-building approach by content leaders and content experts of the ONS Research Agenda Project Team
. CONCLUSIONS The 2014-2018 Research Agenda Project Team identified eight high-priority research areas: symptoms, late effects of cancer treatment and survivorship care, palliative and end-of-life care, self-management, aging, family and caregivers, improving healthcare systems, and risk reduction. In addition, four cross-cutting themes were identified: biomarkers, bioinformatics, comparative effectiveness research, and dissemination and implementation science. IMPLICATIONS FOR NURSING The Research Agenda is a synthesis of the state of the science in cancer and identifies gaps and directions for the conduct and dissemination of research. Oncology nurses can use the agenda to inform clinical practice, develop research proposals, inform policy makers, support interdisciplinary research efforts, and promote scientist and clinician collaborations in targeted patient-centered research
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